Indian J Surg (June 2013) 75(Suppl 1):S171–S173 DOI 10.1007/s12262-012-0556-y

CASE REPORT

Gastrointestinal Stromal Tumour of Meckel’s Diverticulum Causing Perforation and Peritonitis: A Case Report Richa Goyal & Navneet K. Chaudhary

Received: 25 February 2010 / Accepted: 4 June 2012 / Published online: 16 June 2012 # Association of Surgeons of India 2012

Abstract A 23-year-old man presented with history of fever and pain in the right lower abdomen. He was diagnosed to have acute appendicitis with perforation and was taken up for emergency laparotomy after resuscitation. There was pus in the right iliac fossa and a tumor at the fundus of Meckel’s diverticulum, which had perforated. Appendix was found to be normal. The histopathology examination showed it to be gastrointestinal stromal tumor of Meckel’s diverticulum. The gastrointestinal stromal tumor causing Meckel’s diverticulum perforation and peritonitis is very rare, and prior to this indexed case, only two such cases have been reported in the literature. Keywords Meckel’s diverticulum . Diverticulum . Gastrointestinal stromal tumor

Introduction Meckel’s diverticulum is the most commonly encountered congenital anomaly of the small intestine. The vast majority of Meckel’s diverticula are incidentally discovered during autopsy, laparotomy, or barium studies. Tumors are observed in only 0.5–3.2 % of Meckel’s diverticula, but gastrointestinal stromal tumors are rare in this location. Still rare is gastrointestinal stromal tumor causing Meckel’s N. K. Chaudhary Departments of Pathology and General Surgery, SPS Apollo Hospitals, Ludhiana, Punjab, India R. Goyal (*) SPS Apollo Hospital, Sherpur Chowk, Ludhiana 140004, India e-mail: [email protected]

diverticulum perforation and peritonitis. Here we present one such case.

Case History A 23-year-old man presented with history of fever and pain in the right lower abdomen for the past 2 days. On examination, we found the abdomen mildly distended with tenderness and guarding. There was a vague palpable mass in the right lower abdomen. His general physical examination revealed tachycardia (pulse rate 130/min). The rest of systemic examination did not reveal any abnormality. Clinical diagnosis of acute appendicitis with local peritonitis was made. He was taken up for emergency laparotomy. The operative findings were pus in the right iliac fossa and a large tumor at the fundus of Meckel’s diverticulum, which had perforated. He underwent segmental ileal resection with Meckel’s diverticulectomy and end-to-end ileoileal anastomosis. Grossly, the specimen consisted of 6.2 cm long ileal segment with attached Meckel’s diverticulum on the antimesenteric border, measuring 4.8 cm×4.2 cm×4.2 cm. The serosal aspect of the diverticulum showed hemorrhages and exudate (Fig. 1). On slicing, almost whole of the diverticulum was replaced by the tumor except for partly ulcerated mucosa. The tumor was solid gray white with foci of hemorrhages. The adjoining ileum was unremarkable except for serosal congestion. Microscopic examination showed partly ulcerated small bowel mucosa in the diverticulum with an underlying tumor. The tumor was composed of fascicles and focal whorling arrangement of spindle cells (Fig. 2). The cells showed minimal pleomorphism with only occasional mitotic figures (

Gastrointestinal Stromal Tumour of Meckel's Diverticulum Causing Perforation and Peritonitis: A Case Report.

A 23-year-old man presented with history of fever and pain in the right lower abdomen. He was diagnosed to have acute appendicitis with perforation an...
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